natriuretic-peptide--brain and Renal-Artery-Obstruction

Topics: Aged; Angioplasty, Balloon; Arteriosclerosis; Biomarkers; Diagnostic Imaging; Embolism; Female; Heart Diseases; Humans; Hypertension, Renovascular; Male; Mass Screening; Meta-Analysis as Topic; Middle Aged; Natriuretic Peptide, Brain; Prevalence; Pulmonary Edema; Randomized Controlled Trials as Topic; Recurrence; Renal Artery Obstruction; Stents; Treatment Outcome

Atherosclerotic renal artery stenosis (ARAS) causes hypertension (HTN) and threatens renal function (RF). The HERCULES Trial is a prospective, multicenter trial of renal stenting in patients with uncontrolled HTN and ARAS evaluating the safety and effectiveness of the RX Herculink Elite Renal Stent System (Abbott Vascular, Santa Clara, CA).. A total of 202 patients (241 total lesions; 78 bilateral lesions) were enrolled between August 2007 and October 2009. The primary endpoint was 9-month binary restenosis determined by duplex ultrasound and/or angiography. Secondary endpoints included changes in blood pressure, antihypertensive medications, and RF between baseline and 9 months. Brain natriuretic peptide (BNP) was measured at baseline, 24 hr and 30 days postprocedure.. Mean systolic blood pressure (SBP) at baseline was 162 mm Hg. Nearly 70% of patients were receiving three or more antihypertensive medications (mean 3.4 medications per patient). Baseline serum creatinine was 1.2 ± 0.4 and 61.5% of subjects had estimated glomerular filtration <60. The restenosis rate was 10.5% at 9 months. The study device, procedure, and clinical success rates were 96.0, 99.2, and 98.0%, respectively. Freedom from major adverse events was 94.8%. At 9 months, the mean SBP significantly decreased (mean 145, paired t test P < 0.0001) after stenting with no change in medications. There was no correlation between SBP reduction and baseline BNP or BNP reduction.. HERCULES demonstrates clinically and statistically significant SBP reduction in patients with uncontrolled HTN, low in-stent restenosis, and complication rates. This study highlights that when appropriate patients are selected for renal artery stenting, impressive reductions in blood pressure may be anticipated. Although the magnitude of absolute reduction in SBP was related to baseline SBP, elevated baseline BNP levels were not predictive of reduction in SBP. Further studies for predictors of clinical response following percutaneous renal revascularization are needed.

Topics: Aged; Angioplasty, Balloon; Antihypertensive Agents; Atherosclerosis; Biomarkers; Blood Pressure; Creatinine; Drug Therapy, Combination; Female; Glomerular Filtration Rate; Humans; Hypertension, Renovascular; Kaplan-Meier Estimate; Male; Natriuretic Peptide, Brain; Prospective Studies; Recurrence; Renal Artery Obstruction; Stents; Time Factors; Treatment Outcome; United States

The purpose of this study was to evaluate the utility of B-type natriuretic peptide (BNP) to predict blood pressure (BP) response in patients with renal artery stenosis (RAS) after renal angioplasty and stenting (PTRA).. In 120 patients with RAS and hypertension referred for PTRA, 24-h ambulatory BP recordings were obtained before and 6 months after intervention. BNP was measured before, 1 day and 6 months after PTRA.. BP improved in 54% of patients. Median BNP levels pre-intervention were 97 pg ml(-1) (interquartile range (IQR) 35-250) and decreased significantly within 1 day of PTRA to 62 pg ml(-1) (IQR 24-182) (p < 0.001), remaining at 75 pg ml(-1) (IQR 31-190) at 6 months. The area under the receiver operating curve for pre-intervention BNP to predict BP improvement was 0.57 (95% confidence interval (CI) 0.46-0.67). Pre-intervention BNP >50 pg ml(-1) was seen in 79% of patients with BP improvement compared with 56% in patients without improvement (p = 0.01). In a multivariate logistic regression analysis, BNP >50 pg ml(-1) was significantly associated with BP improvement (odds ratio (OR) 4.0, 95% CI 1.2-13.2).. BNP levels are elevated in patients with RAS and decrease after revascularisation. Although BNP does not seem useful as a continuous variable, pre-interventional BNP >50 pg ml(-1) may be helpful to identify patients in whom PTRA will improve BP.

Topics: Aged; Angioplasty; Blood Pressure Monitoring, Ambulatory; Female; Humans; Hypertension; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Prospective Studies; Renal Artery Obstruction; Stents

To identify candidates for PTRA in terms of the preservation of renal function, we herein evaluated factors that caused worsening renal function (WRF) after PTRA.. We evaluated 92 patients with atherosclerotic renal artery stenosis (mean age 70.7 ± 8.4 years). WRF was defined as a ≥0.3 mg/dL increase in creatinine levels after PTRA compared to before PTRA.. A total of 92 patients exhibited non-WRF 83 (90.2%), WRF 9 (9.8%). Significant differences were observed in serum creatinine levels between two groups both before (non-WRF 1.34 ± 0.49 versus WRF 1.70 ± 0.68 mg/dL, p = 0.0462) and after PTRA (non-WRF 1.31 ± 0.43 versus WRF 2.42 ± 1.12 mg/dL, p < 0.0001). Patients with WRF had higher comorbidity rate of diabetes mellitus (DM) (non-WRF 31.3% versus WRF 66.7%, p = 0.0345) and proteinuria (non-WRF 27.7% versus WRF 66.7%, p = 0.0169), and had higher systolic blood pressure (non-WRF 143.6 ± 18.7 versus WRF 157.1 ± 19.9 mmHg, p = 0.0436), higher plasma B-type natriuretic peptide (BNP) levels, and larger left atrial and left ventricular end-diastolic dimensions before PTRA. Patients with WRF had a higher rate of taking diuretics (non-WRF 27.7% versus WRF 66.7%, p = 0.0169) after PTRA. Multiple logistic regression analysis revealed that comorbidity of DM was an independent related factor for WRF (comorbidity of DM, yes: OR 31.0, 95% CI 2.44-1024.62, p = 0.0055).. Comorbidity of DM, coexisting of proteinuria, high creatinine level, high blood pressure, high BNP levels, and large left atrial and ventricular dimensions were related to WRF after PTRA in patients with atherosclerotic renal artery stenosis.

Topics: Aged; Angioplasty; Diabetes Mellitus; Female; Humans; Hypertension; Hypertrophy, Left Ventricular; Kidney; Kidney Function Tests; Male; Natriuretic Peptide, Brain; Renal Artery; Renal Artery Obstruction; Renal Insufficiency; Risk Factors

Although RAS is a relatively uncommon cause of hypertension, it is the most common form of correctable hypertension. There are clinical clues to be gained in identifying the small subset of individuals in whom directed evaluation for RAS may be useful. But its diagnostic accuracy is still poor.. The aim of the present study is to determine the usefulness of N-terminal pro-brain natriuretic peptide (NT-pro BNP) levels in helping improved diagnostic accuracy of a significant renal artery stenosis (RAS) in medically refractory hypertensive patients.. The present study included 40 patients with medical refractory hypertension in whom RAS was suspected and who were undergoing magnetic resonance angiogram (MRA) of renal artery and/or renal angiogram. Twenty consecutive patients with a significant RAS by MRA or renal angiogram (RAS group) compared with 20 consecutive patients in whom RAS was suspected but whose MRA/renal angiogram was normal or non-significant (normal group). Baseline clinical characteristics, number of antihypertensive medications before the procedure and NT-pro BNP were obtained from both groups.. Age, gender glomerular filtration rate (GFR) and LV function did not differ significantly between the two groups. NT-pro BNP level was significantly higher in RAS group (1,243 ng/ml, range 156-10,628 ng/ml) compared to normal group (129 ng/ml, range 61-3,457 ng/ml), p = 0.009. NT-proBNP level > or = 600 ng/ml has sensitivity and specificity of 80% and 95%, respectively, in diagnosis of significantRAS.. In medical refractory hypertensive patients, NT-pro BNP level increased in patients with significant RAS and was an aid in separating a significant RAS from non-significant/normal renal artery.

Topics: Biomarkers; Female; Humans; Hypertension; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Renal Artery Obstruction

We hypothesized that plasma levels of brain natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) would be elevated, and adiponectin concentrations reduced, in patients with atherosclerotic renal artery stenosis (ARAS) and that BNPs might be used to identify patients who would benefit from percutaneous transluminal renal angioplasty (PTRA).. Data were collected before renal angiography in 91 patients with hypertension and suspected ARAS (significant ARAS; n=47, and non-RAS; n=44) and in 20 healthy controls (C). In ARAS patients analyses were repeated four weeks after PTRA.. Ambulatory systolic blood pressure (ASBP) was significantly elevated in the ARAS group vs. both C and non-RAS groups. Baseline plasma BNP and NT-proBNP levels were significantly elevated, and adiponectin concentrations reduced, in the ARAS group vs. C but not vs. the non-RAS group. One month after PTRA, ASBP was reduced vs. baseline (149±16 to 139±15 mm p<0.01). Brain natriuretic peptides were not significantly affected by PTRA.. Patients with ARAS showed elevated of BNP and NT-proBNP concentrations, and reduced levels of adiponectin, compared to healthy controls but not vs. hypertensive individuals without RAS. Our data do no support the use of BNP analyses in the identification of ARAS patients who will have a beneficial blood pressure response to PTRA.

Topics: Adiponectin; Aged; Angioplasty; Atherosclerosis; Biomarkers; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Radiography; Renal Artery; Renal Artery Obstruction

Patients with atherosclerotic renovascular disease (ARVD) are at increased risk of heart disease because of associated hypertension, coronary artery disease, cardiac failure and chronic kidney disease. Although suggested to be beneficial, the cardiac effects of renal artery revascularization have not been well characterized. Our aim was to analyze the effects of percutaneous dilatation of renal artery stenosis (RAS) in ARVD patients on coronary and peripheral vascular function.. Nineteen ARVD patients [11 females and 8 males, age at study entry (mean ± SD) 69 ± 10 years] were treated by dilatation of unilateral (n = 9) or bilateral (n = 10) RAS, mainly because of uncontrolled or refractory hypertension. The patients were studied before and after the procedure (103 ± 29 days). They underwent echocardiography and peripheral artery endothelial function testing using flow-mediated dilatation (FMD) of brachial artery at rest and during reactive hyperemia. Myocardial blood flow was measured using quantitative PET perfusion imaging at baseline and during dipyridamole-induced hyperemia.. Peripheral endothelial function, tested by FMD, as well as systolic blood pressure and left ventricular mass were improved in patients with bilateral RAS. However, myocardial perfusion and coronary flow reserve (CFR) did not change after the RAS dilatation.. This is the first study to analyze the stage of myocardial perfusion and CFR in ARVD patients. Although peripheral endothelial function, systolic blood pressure and left ventricular hypertrophy were improved in patients with bilateral RAS by revascularization of RAS, it did not have any effect on coronary perfusion.

Topics: Aged; Aged, 80 and over; Angioplasty, Balloon; Atherosclerosis; Blood Pressure; Brachial Artery; Coronary Circulation; Echocardiography; Female; Humans; Male; Middle Aged; Myocardial Perfusion Imaging; Natriuretic Peptide, Brain; Positron-Emission Tomography; Renal Artery Obstruction

Patients with aortic valve sclerosis (AVS) have an increased risk of cardiovascular events. Patients with atherosclerotic renal artery stenosis (RAS) develop resistant hypertension and heart failure. We hypothesized AVS may be copresent with RAS in hypertensive patients.. Hypertensive patients with AVS (n = 167) underwent magnetic resonance (MR) angiography using nonenhanced steady-state free precession (SSFP) technique. More than 75% luminal narrowing in the proximal region of main renal artery was regarded as significant RAS. Peak aortic jet velocity was obtained by Doppler echocardiography. We measured brain natriuretic peptide (BNP), and estimated glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease equation.. Unilateral or bilateral RAS was detected in 40 patients. AVS patients with RAS were older (78 +/- 6 vs. 74 +/- 8 years), and had higher levels of aortic jet velocity (162 +/- 4 vs. 144 +/- 3 cm/s), and lower levels of GFR (55 +/- 13 vs. 62 +/- 14 ml/min/1.73 m(2)) than those without RAS. Higher aortic jet velocity (odds ratio (OR) = 1.58, 95% confidence interval (CI) = 1.09-2.31) and lower GFR (OR = 0.54, 95% CI = 0.33-0.38) were associated with the presence of RAS, after being adjusted for age, systolic blood pressure, and BNP.. RAS was detected in hypertensive patients with AVS, particularly in patients with higher aortic jet velocity and lower GFR. Higher aortic jet velocity and lower GRF may be useful as a potential indicator for those needing assessment of RAS for risk stratification and deserves further study.

Topics: Aged; Aortic Valve; Atherosclerosis; Diet; Female; Glomerular Filtration Rate; Heart Function Tests; Humans; Hypertension; Kidney Function Tests; Logistic Models; Magnetic Resonance Angiography; Male; Natriuretic Peptide, Brain; Odds Ratio; Renal Artery; Renal Artery Obstruction; Sclerosis; Ultrasonography

Renovascular hypertension caused by renal artery stenosis (RAS) accounts for 3-5% of all cases of hypertension.. The aim of the study was to determine the association between SNP rs198389 (T-381 C) polymorphism in the B-type natriuretic peptide promoter (BNP) gene and the degree of RAS in patients with atherosclerotic renovascular hypertension.. Thirty-six patients scheduled for invasive diagnostic evaluation of atherosclerotic renovascular hypertension were enrolled in the study. Arteriography was performed through a femoral artery access. In order to identify SNP rs198389 (T-381 C) polymorphism in the BNP gene genotyping was performed using genomic DNA isolated from peripheral blood leukocytes. Amplified by polymerase chain reaction and purified product was used to minisequencing. Capillary electrophoresis was applied to separate and detect minisequencing products. The analysis enabled to discriminate TC heterozygotes, TT homozygotes, and CC homozygotes at position 381 of the BNP gene promoter.. Patients homozygous for C allele occurred more frequently in patients with high-grade RAS in comparison with the moderate and mild stenosis groups. TT homozygotes were observed more frequently in mild stenosis patients compared to the moderate and high-grade stenosis groups. None of the patients who had mild RAS was homozygous for C allele and none of the patients who had severe RAS was homozygous for T allele.. We demonstrated the association between SNP rs198389 (T-381 C) polymorphism in the BNP gene promoter and the degree of RAS in patients with atherosclerotic renovascular hypertension. It appears that subjects homozygous for C allele at position 381 of the BNP precursor gene promoter are more prone to develop atherosclerotic lesions in renal arteries.

Topics: Angiography; Atherosclerosis; Female; Genotype; Humans; Hypertension, Renovascular; Male; Middle Aged; Natriuretic Peptide, Brain; Polymorphism, Single Nucleotide; Renal Artery Obstruction

Patients with atheromatous renovascular disease (ARVD) have high cardiovascular morbidity and mortality. The cardiac markers N-terminal pro-brain natriuretic peptide (NT-proBNP) and troponin (cTnT) are easily measured, yet not widely used in renal patients as they are thought to be inaccurate in renal disease. We aimed to see if these markers could be used as prognostic indicators of cardiovascular events (CVEs) and death in ARVD.. Subjects with ARVD treated in 1 renal center in 2003 were prospectively followed up. NT-proBNP and cTnT at baseline were correlated with CVEs and death, echocardiographic findings and degree of renal artery stenosis. Cutoff levels of 0.03 ng/ml (cTnT) and 43 pmol/l (NT-proBNP) were used.. Eighty-two patients (mean +/- SD age 69 +/- 8 years, mean follow-up 40.2 +/- 16.6 months) were suitable for analysis. Twenty-nine percent of patients suffered new CVEs, and 37.8% died. Renal function was a significant predictor of CVEs and death. Patients with a raised NT-proBNP were more likely to die than those in the same chronic kidney disease (CKD) category with normal levels (p < 0.0001) even after adjusting for multivariate factors (hazard ratio 8.3 for high proBNP vs. 3.6 for low proBNP in CKD stage 4-5).. No study to our knowledge has looked at both NT-proBNP and cTnT as outcome markers in ARVD. Our study shows that renal function is more important as a marker of suffering a CVE. However, raised NT-proBNP is associated with a greater likelihood of death when subdivided by CKD stage. Early risk stratification by simple measurement of these biomarkers may aid in intensifying management in high-risk patients, although further studies to assess the value of this approach are warranted.

Topics: Aged; Aged, 80 and over; Biomarkers; Cardiovascular Diseases; Female; Follow-Up Studies; Glomerular Filtration Rate; Humans; Kidney; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; Renal Artery Obstruction; Risk Factors; Survival Rate; Troponin

Topics: Atrial Natriuretic Factor; Humans; Kidney; Natriuretic Peptide, Brain; Peptide Fragments; Renal Artery; Renal Artery Obstruction; Renal Veins

A significant number (20% to 40%) of hypertensive patients with renal artery stenosis will not have blood pressure improvement after successful percutaneous revascularization. Identifying a group of patients with refractory hypertension and renal artery stenosis who are likely to respond to renal stent placement would be beneficial.. Brain natriuretic peptide (BNP) was measured in 27 patients with refractory hypertension and significant renal artery stenosis before and after successful renal artery stent placement. This neuropeptide was elevated (median, 187 pg/mL; 25th to 75th percentiles, 89 to 306 pg/mL) before stent placement and fell within 24 hours of the successful stent procedure (96 pg/mL; 25th to 75th percentiles, 61 to 182 pg/mL; P=0.002), remaining low (85 pg/mL; 25th to 75th percentiles, 43 to 171 pg/mL) at follow-up. Clinical improvement in hypertension was observed in the patients with a baseline BNP >80 pg/mL (n=22) in 17 patients (77%) compared with 0% of the patients with a baseline BNP < or =80 pg/mL (n=5) (P=0.001). After correction for glomerular filtration rate, BNP was strongly correlated with improvement in hypertension.. BNP is increased in patients with severe renal artery stenosis and decreases after successful stent revascularization. In addition, an elevated baseline BNP level of >80 pg/mL appears to be a good predictor of a blood pressure response after successful stent revascularization.

Topics: Aged; Biomarkers; Blood Pressure; Female; Glomerular Filtration Rate; Humans; Hypertension; Male; Natriuretic Peptide, Brain; Renal Artery Obstruction; Stents; Vascular Surgical Procedures